Open Access Research article

Simplifying ART cohort monitoring: Can pharmacy stocks provide accurate estimates of patients retained on antiretroviral therapy in Malawi?

Hannock Tweya12*, Caryl Feldacker23, Anne Ben-Smith4, Anthony D Harries15, Ryuichi Komatsu6, Andreas Jahn7, Sam Phiri2 and Jean-Michel Tassie8

Author Affiliations

1 International Union against Tuberculosis and Lung Disease, Paris, France

2 The Lighthouse Trust, P.O. Box 106, Lilongwe, Malawi

3 International Training and Education Center for Health (I-TECH), University of Washington, 901 Boren Avenue, Suite 1100, Seattle, Wa, 98104-3508, USA

4 Maame Akua, 43/2/391, Lilongwe, Malawi

5 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK

6 Global Fund to Fight Against AIDS, Tuberculosis and Malaria, Geneva, Switzerland

7 Department of HIV/AIDS, Ministry of Health, PO Box 30377, Lilongwe, Malawi

8 HIV/AIDS Department, WHO, Geneva, Switzerland

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BMC Health Services Research 2012, 12:210  doi:10.1186/1472-6963-12-210

Published: 20 July 2012



Routine monitoring of patients on antiretroviral therapy (ART) is crucial for measuring program success and accurate drug forecasting. However, compiling data from patient registers to measure retention in ART is labour-intensive. To address this challenge, we conducted a pilot study in Malawi to assess whether patient ART retention could be determined using pharmacy records as compared to estimates of retention based on standardized paper- or electronic based cohort reports.


Twelve ART facilities were included in the study: six used paper-based registers and six used electronic data systems. One ART facility implemented an electronic data system in quarter three and was included as a paper-based system facility in quarter two only. Routine patient retention cohort reports, paper or electronic, were collected from facilities for both quarter two [April–June] and quarter three [July–September], 2010. Pharmacy stock data were also collected from the 12 ART facilities over the same period. Numbers of ART continuation bottles recorded on pharmacy stock cards at the beginning and end of each quarter were documented. These pharmacy data were used to calculate the total bottles dispensed to patients in each quarter with intent to estimate the number of patients retained on ART. Information for time required to determine ART retention was gathered through interviews with clinicians tasked with compiling the data.


Among ART clinics with paper-based systems, three of six facilities in quarter two and four of five facilities in quarter three had similar numbers of patients retained on ART comparing cohort reports to pharmacy stock records. In ART clinics with electronic systems, five of six facilities in quarter two and five of seven facilities in quarter three had similar numbers of patients retained on ART when comparing retention numbers from electronically generated cohort reports to pharmacy stock records. Among paper-based facilities, an average of 13 4 hours was needed to calculate patient retention for cohort reporting using patient registers as compared to 2.25 hours using pharmacy stock cards.


The numbers of patients retained on ART as estimated using pharmacy stock records were largely similar to estimates based on either paper registers or electronic data system. Furthermore, less time and staff effort was needed to estimate ART patient retention using pharmacy stock records versus paper-based registers. Reinforcing ARV stock management may improve the precision of estimates.

Antiretroviral therapy; Pharmacy stock records; Patient retention; Quality improvement